Fluid from the body’s tissues drains into the lymphatic vessels, which are close to the blood vessels. This fluid is called lymph. Lymphatic vessels carry the lymph fluid to lymph nodes where substances that could be harmful, such as bacteria, are filtered out and destroyed. This process helps to protect the body against infection. The lymph then passes back into the main blood vessels. There are bundles of lymph nodes all around the body including the abdomen, armpit, groin, chest and neck. Lymphoedema is not the same as the swelling or pain that immediately follows surgery and radiation therapy to lymph nodes.
Types of lymphoedema:
Primary Lymphoedema– a rare, inherited condition where the lymph nodes and lymph vessels are absent or abnormal.
Secondary Lymphoedema– can occur following treatment for cancer, when lymph nodes are surgically removed or damaged from radiotherapy. This can stop the lymph fluid from flowing freely through the lymphatic system. It can also cause fluid to build up in some parts of the body.
Lymphoedema can affect the arm after treatment to the nodes that lie under the armpit, or swelling can occur in the leg when nodes in the groin are removed. Facial swelling can also occur when nodes in the head and neck are affected.
Lymphoedema can develop months or even years after treatment for cancer. Lymphoedema usually develops gradually.
How common is lymphoedema?
Conservative estimates suggest that approximately 20% of patients treated for melanoma, breast, gynecological or prostate cancer will experience secondary lymphoedema.
What are the signs and symptoms of lymphoedema?
Early signs and symptoms of lymphoedema include:
- A feeling of heaviness, tightness or fullness in the affected limb or body part.
- Swelling – you may notice indentations in the skin from tight clothing, shoes or jewellery.
- Ache, pain or tension in the limb or body part.
- Clothing may feel tight and restrictive around the affected limb or body part.
Some of these early warning signs may come and go. If you notice any of the above changes you should discuss these with your Lymphoedema Physiotherapist, as well as your GP.
How is lymphoedema managed?
There is no known cure for lymphoedema; however it can be managed with appropriate care. The aim of management is to reduce and control swelling, improve range of movement of the affected area, as well as prevent infections.
General advice if you have developed, or at risk of developing, lymphoedema includes:
- Skin Care – a daily skin care routine is essential for maintaining skin integrity and reducing the risk of developing an infection in the limb or affected body part. Applying regular moisturiser will assist with providing a protective barrier against bacteria.
- Exercise – general exercise is important to maintain a healthy body weight, as well as functional mobility.
Should you develop lymphoedema it is essential you seek advice from a Certified Lymphedema Practitioner so your symptoms can be assessed and managed properly. Treatment recommendations vary depending on the stage of your lymphoedema and the severity of symptoms.
Components of Complete Decongestive Therapy (CDT) provided by your Lymphoedema Practitioner may include:
Compression Garments – these are firmly fitted elastic garments worn over the affected area. Research suggests that wearing a compression garment can help reduce swelling associated with lymphoedema by stopping fluid from building up, and by moving excess fluid out of the affected area. Wearing a compression garment may be recommended when swelling is present, or during certain activities such as sport or air travel. Compression garments need to be fitted professionally by your Lymphoedema Practitioner, and generally need to be replaced every six to twelve months as they lose their elasticity.
Manual Lymphatic Drainage(MLD) – this is a special form of massage to the affected area. MLD aims to improve the way lymphatic vessels work, and helps reduce the build up of fluid. It includes slow gentle strokes that stimulate the flow of lymph from the affected area, through the remaining lymph vessels to nearby functional lymphatic vessels and lymph nodes. Your Lymphoedema Practitioner can teach you how to perform self manual lymph drainage outside of therapy sessions.
Exercise – appropriate exercise is an important component to the management of lymphoedema. Exercises should be prescribed by your Lymphoedema Practitioner. They will assist with the efficient flow of lymph fluid away from the affected area. Maintaining regular physical activity is also paramount to maintaining a healthy body weight. Excess body weight can provide external pressure to the delicate lymph collecting and transport vessels, further restricting lymphatic flow. A lower body weight also means there is less tissue from which the lymph fluid has to drain.
Compression Bandaging – this is usually performed in combination with MLD, and then followed by the measuring and fitting of a compression garment. The aim of compression bandaging is to reduce the severe swelling of the affected area prior to the fitting of the compression garment, or if the skin is fragile or damaged. These bandages must be applied by a qualified Lymphoedema Practitioner, and should be checked and replaced at regular intervals.
Skin Care – adequate skin care with the daily application of an appropriate moisturiser (discuss this with your Lymphoedema Practitioner) is important as it provides a barrier against infection. Lymphoedema predisposes you to potential skin break down and infections if not monitored and cared for appropriately. If you have lymphoedema and the affected area swells quickly, or becomes red and warm, you need to arrange an urgent appointment with your doctor. You should let your doctor know you may have cellulitis (an infection of the skin and underlying tissue) that needs to be treated with antibiotics.
Good skin care reduces the likelihood of cellulitis, and consequently the need for antibiotics.
Key tips for managing your lymphoedema:
There are some actions you can take to reduce your risk of developing lymphoedema, or to help stop the condition from getting worse.
- Keep your skin healthy – the skin is an important barrier in protecting your body against infection. If there is a break in the skin this will increase your risk of developing an infection, such as cellulitis. Developing an infection may worsen the lymphoedema in the affected body part. Tips to help keep your skin healthy and reduce the risk of infection include:
- Keeping the skin supple with the daily use of a non-perfume moisturising cream.
- Avoid drying out your skin and consider using soap free alternatives.
- Ensure you clean any cuts, grazes or scratches immediately with an antiseptic solution. Use an antibacterial cream and cover the area with a clean, dry plaster.
- Use an electric razor for shaving, rather than a wet razor.
- Protect your skin with gloves when doing things like handling pets, gardening or washing dishes.
- Foot care is essential for individuals that have developed lymphoedema of the lower limb. It is important to:
- Ensure your feet are covered when outdoors.
- Make sure your feet remain warm and dry, and wear cotton socks.
- Check your feet regularly to monitor for tinea or infections, and treat promptly.
- Ensure you prevent ingrown toe nails and take care when cutting your nails.
- Wear well fitted shoes at all times.
- It is essential that you maintain regular physical activity.
- Maintain a healthy body weight.
- Avoid long periods of inactivity.
- Talk to your Lymphoedema Practitioner to discuss what activities are best suited to you.
- Avoid things that will place extra strain on the lymphatic system, such as:
- Getting sunburn on the affected area.
- Hot baths, spas, and saunas.
- Strenuous exercise in hot weather.
- Poorly fitted footwear or tight restrictive clothing.
It has been suggested that long-distance air, road or train travel may increase the risk of developing lymphoedema. While the evidence for this is not strong, it may be helpful to wear a compression garment and to perform gentle exercises while you travel. If you are planning a trip, it is important you discuss this with your Lymphoedema Practitioner for the appropriate advice.